Problemas relacionados con los medicamentos detectados en pacientes hospitalizados a través de una herramienta informática integrada en la orden médica informatizada

Abstract

Background _x000D_ The potential impact of drug-related problems (DRP) on morbidity and mortality is a serious concern and leads to the need to study them in order to design monitoring and prevention strategies._x000D_ Purpose: _x000D_ The assesment of DRPs detected by a computerized electronic system in hospitalized patients integated in the electronic medical record._x000D_ Purpose 1 (first article): to design a risk score to identify patients most at-risk of a DRP in hospitalized patients_x000D_ Purpose 2 (second article): to identify the profile of patients at higher risk of developing at least one DRP during hospitalization in a cardiology ward._x000D_ Methods: _x000D_ These studies were conducted in Hospital Universitari del Mar with 431 beds (413 conventional beds plus 18 beds for critically-ill patients) during 2009. The cardiology ward has approximally 30 hospital beds. _x000D_ DRPs were detected by a Pharmacy warning system designed by the Pharmacy Service integrated in the electronic medical record and classificated using the classification of the Pharmaceutical Care Network Europe (PCNE)._x000D_ In both studies the variables associated with developing a DRP were identified through a binary multivariate logistic regression analysis. _x000D_ For purpose 1 (first article)_x000D_ Data from patients admitted to the hospital between January and August 2009 were used to design the risk score (training set). The variables associated with developing a DRP were used to compute the DRP risk score, which was subsequently validated in patients admitted between September and December 2009 (validation set)._x000D_ For purpose 2 (second article)_x000D_ The DRP according to the cardiac disease present in admitted patients were recorded. _x000D_ Results: _x000D_ For purpose 1 (first article):_x000D_ Of the 8,713 patients included in the training set, at least one DRP was detected in 2,425 (27.8%). Prescription of a higher number of drugs, higher comorbidity, advanced age, certain groups of the Anatomical Therapeutic Chemical classification system, and some major diagnostic categories were associated with risk of DRP. These variables were used to compute the DRP risk score. The area under the receiver operator characteristic curve was 0.778 (95% CI: 0.768-0.789). Of the 4,058 admissions included in the validation set, at least one DRP was detected in 876 (21.6%). The area under the receiver operator characteristic curve was 0.776 (95% CI: 0.759-0.792)._x000D_ For purpose 2 (second article): _x000D_ A total of 964 admissions were included and at least one drug-related problem was detected in 29.8%. The variables associated with a higher risk of these events were polypharmacy (OR: 1.228; 95% CI: 1.153-1.308), female gender (OR: 1.496; 95% CI: 1.026-2.180), and first admission (OR: 1.494; 95% CI:1.005-2.221)._x000D_ Conclusions: _x000D_ For purpose 1 (first article):_x000D_ The present study designed and validated a score that quantifies the risk of a DRP during hospital admission. The application of this score in daily clinical practice can identify those patients most at risk of a DRP_x000D_ For purpose 2 (second article): _x000D_ This study has found that the variables associated with a higher risk of DRP were polypharmacy, female gender, and first admission during admission in a cardiology ward._x000D_ Knowledge of the variables associated with DRP could aid their early detection in at-risk patients and for better monitoring of their prescriptions.

Date of Award	25 Nov 2015
Original language	Undefined/Unknown
Awarding Institution	Hospital del Mar
Supervisor	Olivia Ferrández Quirante (Director), Pere Saballs Radresa (Director) & Santiago Grau Cerrato (Director)